DRIVER QUALIFICATION PACKET

FOR THE TII FAMILY OF COMPANIES

__________________________ Print Drivers Name

This Driver Qualification Packet is intended for:

Please which TII Family of Companies you are applying for:

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MINIMUM QUALIFICATION REQUIREMENTS

The following minimum qualification standards were adopted by the TII family of companies in considering an applicant for a driving position. GENERAL Driver applicant must be 23 years of age or older.

No commercial transportation related felony, theft or larceny conviction within the applicant’s lifetime that resulted in an

active prison or jail sentence. All other non-transportation related convictions will be subject to review at the discretion of

the company and/or its insurance company.

Two years verifiable experience in the past five years operating a tractor-trailer unit over the road, with a motor carrier

This experience to include a minimum of one year’s experience with the type of trailer the applicant will pull

* Marathon Transport applicants please see the experience exceptions below *

* American Wind Transport Group applicants please see the additional experience and requirements below *

HEAVY HAUL, OVER DIMENSIONAL & WIND ENERGY Two years using the type of equipment being used / leased

Two years hauling the type of loads being moved

Multi axle endorsement on CDL (Doubles and Triples)

LCV (Long Combination Vehicle) certification card (if required for equipment being used / leased)

No cargo claims in the past 3 years

No over height claims

MVR - No more than 2 moving violations in the past 3 years

No Preventable Accidents in the past 3 years (police report must be submitted to safety) (no more than 2 non-

preventable)

MARATHON TRANSPORT EXPERIENCE EXCEPTIONS

One year verifiable experience in the past five years operating a tractor-trailer unit, over the road, with a motor carrier.

This experience to include a minimum of three months experience with the type of trailer the applicant will pull.

Super Loads are not permitted or insured under Marathon Transport.

The nature and severity of any of the items referenced above, as well as the driver's record viewed in totality (see MVR Qualification Standards next page), may be sufficient cause for declination of the application, termination and / or lease cancellation.

Driver Motor Vehicle Record (MVR) Qualification Standards

Drivers may not exceed 3 MVR points to be qualified and can not have any of the disqualification violations within the given time period. All accidents in commercial motor vehicles may be weighted higher considering a risk base. Any current qualified and / or leased drivers exceeding the qualification point values will be placed on probation, re-trained and / or cancelled. The following standards were set in accordance with Federal Motor Carrier Regulations and Insurance company’s guidance.

I hereby certify that I have read the minimum requirements and that the information that I supplied prior to qualification was in compliance with these requirements.

______________________________________ _________________

Driver’s Signature Date

Violations (1 Point) if within the last 3 yrs Speed 1-9 mph over posted Accident (non-fault) Seat Belt Improper stop on highway Improper U-Turn Improper backing or turning

Violations (2 Points) if within the last 3 yrs Speed 10-14 mph Accident (at-fault) New Lease Preventable Accident Improper Lane Change Failure to Yield Failure to obey traffic control device Operating while texting and /or cell phone Speeding work / construction zone

Violations (3 Points) if within the last 3 yrs Speed 15-20 mph Careless Driving Following too Close Operating a commercial vehicle without

the proper endorsement Operating a vehicle with a suspended

license

Disqualification if within last 5 years or lifetime Operating a commercial motor vehicle without

obtaining a CDL (5 yrs) Operating a vehicle with a suspended license

(Suspended for moving violations, manager review) (5 yrs)

Leaving the scene of an accident (5 yrs) DUI/DWI, Drug or Alcohol Use / Possession

(5) False report to department (lifetime) Fraudulent use of driver’s license (lifetime) Hit and Run (5) Homicide with a MV (lifetime) At fault accident with a fatality (lifetime) Manslaughter with a MV(lifetime) Passing a school bus (5) Participating in racing (5) Railroad Crossing Violation (5) Eluding a police officer (lifetime) Using the vehicle in the commission of a

felony involving manufacturing, distributing, or dispensing a controlled substance (lifetime)

Refusing to take an alcohol test as required by a state or jurisdiction under its implied consent laws or regulations (lifetime)

Disqualification if within the last 3 yrs Failure to report an accident Failure to stop, aid, or identify Reckless Driving Wrong way on highway 2 or more at fault accidents Allowing non-licensed operator Speed 21+ Violating a driver or vehicle out-of-service

order (commercial operation)

THIS INFORMATION HEREIN REQUESTED PURSUANT TO REGULATIONS OF THE U.S. DEPARTMENT OF TRANSPORTATION Date: _____________________ Social Security Number: _____________________ Name: Date of Birth: ___________________________ Last First Middle Mobile Phone: ______________________ Home Phone: ____________________ Email: ________________________ Address for the previous (3) years:

Street City State Zip How long? Current:

Previous:

Previous: In case of an emergency, notify: _________________________________________ Relationship: __________________ Address: ___________________________________________________________ Phone: (_____) ________________ Driver’s license held in that past 5 years

State License Number Type Endorsements Expiration Date

Current:

Previous:

Previous:

Have you ever had any license, permit, or privilege to operate a motor vehicle which was issued to you revoked, withdrawn, suspended or your application denied? Yes / No **If “Yes” list the facts and circumstances of each occurrence.

Commercial driving experience

Class of equipment Number years of experience Approximate number of miles driven

Straight Truck

Tractor Trailer

Bus

Other

COMPLETE THIS APPLICATION CAREFULLY Every question MUST be answered.

Any false or inaccurate answer may be cause for immediate dismissal.

PREVIOUS EMPLOYMENT HISTORY

**Show all employment for the past 10 years with NO gaps.** (Ex. If unemployed at any time throughout your 10 year history; please list Unemployed and the dates.)

List employers in reverse order, starting with the most recent. Add another sheet if necessary.

Current or last employer Carrier’s Name: OD/OW? Yes / No

City State Zip:

Phone: Date of employment: ____/____/____ to ____/____/____

Reason for leaving: Trailer Type:

Were you subject to the FMCSRs while employed? Yes / No

Was your job designated as a safety-sensitive function in any DOT regulated mode subject to the drug & alcohol testing requirements of 49 CFR Part 40? Yes / No

May we contact this employer if currently employed? Yes / No

Second to last employer Carrier’s Name: OD/OW? Yes / No

City State Zip:

Phone: Date of employment: ____/____/____ to ____/____/____

Reason for leaving: Trailer Type:

Were you subject to the FMCSRs while employed? Yes / No

Was your job designated as a safety-sensitive function in any DOT regulated mode subject to the drug & alcohol testing requirements of 49 CFR Part 40? Yes / No

Third to last employer Carrier’s Name: OD/OW? Yes / No

City State Zip:

Phone: Date of employment: ____/____/____ to ____/____/____

Reason for leaving: Trailer Type:

Were you subject to the FMCSRs while employed? Yes / No

Was your job designated as a safety-sensitive function in any DOT regulated mode subject to the drug & alcohol testing requirements of 49 CFR Part 40? Yes / No

Four to last employer Carrier’s Name: OD/OW? Yes / No

City State Zip:

Phone: Date of employment: ____/____/____ to ____/____/____

Reason for leaving: Trailer Type:

Were you subject to the FMCSRs while employed? Yes / No

Was your job designated as a safety-sensitive function in any DOT regulated mode subject to the drug & alcohol testing requirements of 49 CFR Part 40? Yes / No

Fifth to last employer Carrier’s Name: OD/OW? Yes / No

City State Zip:

Phone: Date of employment: ____/____/____ to ____/____/____

Reason for leaving: Trailer Type:

Were you subject to the FMCSRs while employed? Yes / No

Was your job designated as a safety-sensitive function in any DOT regulated mode subject to the drug & alcohol testing requirements of 49 CFR Part 40? Yes / No

Sixth to last employer Carrier’s Name: OD/OW? Yes / No

City State Zip:

Phone: Date of employment: ____/____/____ to ____/____/____

Reason for leaving: Trailer Type:

Were you subject to the FMCSRs while employed? Yes / No

Was your job designated as a safety-sensitive function in any DOT regulated mode subject to the drug & alcohol testing requirements of 49 CFR Part 40? Yes / No

Seventh to last employer Carrier’s Name: OD/OW? Yes / No

City State Zip:

Phone: Date of employment: ____/____/____ to ____/____/____

Reason for leaving: Trailer Type:

Were you subject to the FMCSRs while employed? Yes / No

Was your job designated as a safety-sensitive function in any DOT regulated mode subject to the drug & alcohol testing requirements of 49 CFR Part 40? Yes / No

Eighth to last employer Carrier’s Name: OD/OW? Yes / No

City State Zip:

Phone: Date of employment: ____/____/____ to ____/____/____

Reason for leaving: Trailer Type:

Were you subject to the FMCSRs while employed? Yes / No

Was your job designated as a safety-sensitive function in any DOT regulated mode subject to the drug & alcohol testing requirements of 49 CFR Part 40? Yes / No

Ninth to last employer Carrier’s Name: OD/OW? Yes / No

City State Zip:

Phone: Date of employment: ____/____/____ to ____/____/____

Reason for leaving: Trailer Type:

Were you subject to the FMCSRs while employed? Yes / No

Was your job designated as a safety-sensitive function in any DOT regulated mode subject to the drug & alcohol testing requirements of 49 CFR Part 40? Yes / No

Please explain ALL gaps in employment here.

GAP # 1 GAP # 2 GAP # 3 GAP # 4

Please add additional sheets if necessary to ensure ALL gaps are explained.

Dates of first gap in employment are: From ____________ thru ____________ due to: (explain)

Dates of first gap in employment are: From ____________ thru ____________ due to: (explain)

Dates of first gap in employment are: From ____________ thru ____________ due to: (explain)

Dates of first gap in employment are: From ____________ thru ____________ due to: (explain)

Accident Record

List all motor vehicle accidents in which you have been involved during the past three years, specifying the date and nature of each and any fatalities or personal injuries involved. (If None, Write None)

Date State Nature of accident (overturn, rearend, etc.) # of

fatalities # of injuries Commercial Vehicle? Personal Auto

Yes / No Yes / No

Yes / No Yes / No

Yes / No Yes / No

Traffic Convictions & Forfeitures List all violations of motor vehicle laws or ordinances (other than violations involving only parking) of which you have been convicted, or upon charge of which you forfeited bond or collateral, during the past three years. (If None, Write None)

Date State Charge Penalty Commercial Vehicle? Personal Auto

Yes / No Yes / No

Yes / No Yes / No

Yes / No Yes / No

Have you ever been convicted of driving under the influence of drugs and/or alcohol? Yes / No - If “YES” please list dates, penalties and explain in detail. __________________________________________________________________________________________________

__________________________________________________________________________________________________ Have you ever been convicted of a crime? Yes / No - If “Yes” please list dates, penalties and explain in detail.

__________________________________________________________________________________________________

__________________________________________________________________________________________________

APPLICANT CERTIFICATION

I agree and understand that any misrepresentations of information provided herein shall be considered an act of dishonesty and shall constitute sufficient grounds for immediate termination.

I agree and understand that the TII family of companies or its designated agents may investigate my background to ascertain any and all information it deems appropriate, whether same is of record or not, and I release all companies and individuals from any and all liability for any damages in furnishing such information.

I agree to furnish such additional information and complete such examinations as may be required to complete my driver’s qualification packet.

I hereby understand that I, for all matters concerning the TII family of companies, consider myself an independent contractor or an employee of____________________________ and not an employee of any of the TII family of companies.

This certifies that I completed this application, and that all entries on it and the information in it are true and

complete to the best of my knowledge.

Driver’s Signature: _______________________________________ Date: _____________________

Motor Vehicle Driver’s Certification of Violations I certify that the following is a true and complete list of the traffic violations (other than parking violations) for which I have been convicted or forfeited bond or collateral during the past 12 months. If none, please write “NONE”

Date of Conviction Offense Location Type of Vehicle Operated

If no violations are listed above, I certify that I have not been convicted or forfeited bond or collateral on account of any violations required to be listed during the past 12 months. Date Driver’s Signature

________________________

100 Industry Drive Pittsburgh, PA 15275

To be reviewed and completed by the General Office Safety Department

Remarks:

Reviewed by: ________________________________________ _______________________ (Safety Associate’s Signature) Date

Notice to Drivers & Certificate of Compliance

A. NOTICE TO DRIVERS The Commercial Motor Vehicle Safety Act of 1986 provides for a new set of controls over the drivers of commercial vehicles. The new law applies to all drivers operating vehicles and combinations with a gross vehicle weight over 26,000 pounds, and to any vehicle regardless of weight, transporting hazardous material. The following provisions of this legislation became effective July 1, 1987; 1. No driver may possess more than one license, and no motor carrier may use a driver having more than one license. 2. A driver convicted of a traffic violations (other than parking) must notify the motor carrier AND the state which

issued the license to that driver of such conviction within 30 days. 3. Any person applying to work as a commercial vehicle driver must inform the prospective carrier of all previous

employment as the driver of a commercial vehicle for the past 10 years, in addition to any other required information about applicant’s employment history.

4. Any violation is punishable by a fine not to exceed $2,500.00. In addition, the Federal Motor Carrier Safety Regulations now require that a driver who loses any privileges to operate a commercial vehicle or who is disqualified from operating a commercial vehicle must advise the motor carrier the next business day after receiving notification of such action.

To be retained by the motor carrier

B. CERTIFICATION BY DRIVER I hereby certify that I have read and understand the driver provisions of the Commercial Motor Vehicle Safety Act of 1986, which became effective July 1, 1987 Drivers Name (print): _______________________________________ SS#: __________________________

Address: _____________________________________________________________________________________

State: _____________ Type/Class: _______________ License Number: ______________________________

I further certify that the above commercial vehicle license is the only one currently held or that I have surrendered the following licenses to the state indicated. State: _____________ Type/Class: _______________ License Number: ______________________________

State: _____________ Type/Class: _______________ License Number: ______________________________

State: _____________ Type/Class: _______________ License Number: ______________________________

______________________________________ ____________________ Driver’s Signature Date _____________________________________________ _______________________ Reviewed by (Safety Associate Signature) Date

Log Quiz Name: _____________________________ This quiz is not a condition of qualification. It is designated to seek out areas of misunderstanding or lack of knowledge so that we can educate you in the proper preparation of you driver’s daily log and the hours of service regulations. For each of the activities below, circle the line of the log you would use to record the time. (Line 1 = Off Duty, Line 2 = Sleeper Berth, Line 3 = Driving, Line 4 = On Duty, Not Driving) Loading or unloading a vehicle 1 2 3 4 Performing a pre-trip inspection 1 2 3 4 Sleeping in the sleeper berth 1 2 3 4 Riding in the passenger seat 1 2 3 4 Getting your delivery receipt signed 1 2 3 4 Attendance to or reporting an accident 1 2 3 4 Repairing a disabled vehicle 1 2 3 4 Time spent taking a drug or alcohol test 1 2 3 4 When stopped by DOT for over 15 minutes 1 2 3 4 Fueling your vehicle 1 2 3 4 Deadheading to pick up a load 1 2 3 4 When on vacation 1 2 3 4 Circle TRUE or FALSE Your logs are a legal document True False A driver must have a copy of the logs for the last seven days when driving True False You are permitted to drive 11 hours after 10 consecutive hours off duty before you are required to take another 10 hours off duty True False

The regulation limit for on duty time is 14 hours True False It is required to flag mid-trip cargo securement examinations True False The carrier and the driver may be prosecuted for the failure to submit logs True False The carrier and the driver may be prosecuted if the driver falsifies daily logs True False The correct daily mileage driven must be shown on each log True False Logs must be kept up to the last change of duty status True False The driver must record defective equipment that is found in a roadside inspection on the daily inspection report True False

You must place the load number or the name of the shipper and commodity on the log True False Completed logs must be turned into the carrier within 13 days of completion True False You must have a logbook in your possession when on duty True False A driver does not have to note a fuel stop on his log True False When the driver runs into adverse weather or driving conditions, and could have normally made the run legally, he is allowed to drive and additional 2 hours to complete the trip True False

The DOT can declare a driver or the vehicle out of service for… driving over 10 hours under normal conditions True False driving after being on duty for more than 15 hours True False driving after being on duty for over 70 hours in 8 days True False driving a defective vehicle True False The term “On Duty” time means the total hours shown on lines 3 and 4 of the log sheet True False A driver must file logs only on the days he drives True False You must be on duty to submit to a random drug test True False You must be on duty to submit to a random breath alcohol test True False All drivers must have full knowledge of the FMCSA regulations and be in compliance at all times True False

Driver Exam Name: ___________________________ Please circle the correct answer for each of the following questions.

Driver Qualification At least once a year a driver must fill out a form listing all motor vehicle violations that occurred during the previous 12 months. The driver must fill out the form…

1. even if there were no violations 2. only if convicted 3. only if the carrier requires it

In order to be able to drive, a driver must not…

1. have any mental, nervous, or physical problem likely to affect safe driving 2. use amphetamines, narcotics or any habit forming drug(s) 3. have a current alcoholism problem 4. have or use any of the above

If a driver is convicted of 2 serious traffic violations within 3 years the driver’s CDL will be suspended for 60 days. Which of the following is a serious traffic violation?

1. Improper or erratic lane changes 2. Following too closely 3. Speeding; 15 mph or more above the posted speed limit 4. All of the above

When a driver receives notice of license or permit revocation, suspension, or other withdrawal action the driver must…

1. notify the carrier within 72 hours 2. notify the carrier within one week 3. notify the carrier before the end of the next business day 4. take no action since the carrier receives a notice

Driving A driver may not drive faster than posted speed limits…

1. at anytime 2. unless the driver is passing vehicle 3. unless the driver is late and must make a scheduled arrival

A driver is required to perform a pre-trip inspection…

1. once a month 2. once a day, before the vehicle maybe driven 3. once a year

Which of the following is true?

1. If a seatbelt is installed in the vehicle, the driver must have it fastened before beginning to drive 2. A driver may or may not use the seatbelt, depending on the driver’s judgment 3. A driver must use the seatbelt only if required by state law

If a driver gets injured or an illness serious enough to affect the ability to perform duties the driver…

1. must report it at the next scheduled physical 2. can never drive again 3. must take another physical and be re-certified before driving again

If authorized federal or state inspectors find a vehicle that is likely to cause an accident or breakdown…

1. it will be reported to the carrier for repair during next scheduled maintenance 2. it will be reported to the carrier for repair at the end of the trip 3. it will be marked with an “out of service vehicle” sticker and not driven until repairs are made

Drugs & Alcohol

Drivers required to undergo a random or post accident drug and/or breath alcohol test are required to 1. proceed directly to the collection site 2. log the entire duration of the test collection as on duty - not driving 3. log the collection at the precise location of the collection site 4. all of the above

A driver may not drink or be under the influence of any alcoholic beverage, regardless of the alcoholic content within how many hours of going on duty or driving?

1. 4 hours 2. 6 hours 3. 8 hours 4. 12 hours

After being in an accident that requires you to submit to a breath alcohol test, you are required to…

1. avoid being tested 2. test no less than 12 hours after the time of the accident 3. test within 2 hours but no greater than 8 hours after the time of the accident 4. wait 24 hours after the time of the accident before testing

CSA Your fire extinguisher must be

1. labeled 2. fully charged 3. easily accessible for use and securely mounted 4. all of the above

Tread dept of your steer tires must be at least______to be legal

1. 2/32nds 2. 4/32nds 3. 5/32nds 4. 1/32nds

Trailer tires must be at least______ tread depth to be legal

1. 2/32nds 2. 4/32nds 3. 5/32nds 4. 1/32nds

What percentage of your exterior lights (tractor and trailer) must be operative?

1. 10% 2. 25% 3. 50% 4. 100%

Which of the following is not one of the seven measured areas for CSA?

1. Driver fitness 2. Cargo 3. Unsafe driving 4. Behavior

Health Questionnaire This questionnaire is not a condition of qualification. PLEASE ANSWER ALL OF THE FOLLOWING

QUESTIONS. If a question requires am answer to be written out, use a separate sheet of paper. Please be as complete in your answers as possible.

Vision Do you need glasses to read? Yes No Do you need glasses to see at a distance? Yes No Does your CDL require that you wear glasses when driving? Yes No Do you wear contact lenses? Yes No Do you suffer from any eye ailments? Yes No Diabetes Have you been diagnosed as having diabetes? Yes No If yes, complete the following questions… Is your diabetes regulated by diet only? Yes No Is your diabetes regulated by oral medication? Yes No Is you diabetes regulated by insulin injections? Yes No Epilepsy Have you ever been diagnosed as having epilepsy? Yes No Have you ever suffered from seizures? Yes No Do you currently suffer from seizures? Yes No Do you take medication(s) designed to control seizures? Yes No Respiration Do you have difficulty breathing? Yes No Do you have asthma? Yes No Do you have emphysema? Yes No Are you receiving treatment for asthma? Yes No Are you receiving treatment for emphysema? Yes No If you have asthma or emphysema does strenuous activity aggravate your condition? Yes No Hernia or Rupture Have you ever had a hernia? Yes No If yes, has the hernia been surgically repaired? Yes No Have you ever been advised to have corrective surgery for a hernia? Yes No Have you ever had a rupture? Yes No If yes, has the hernia been surgically repaired? Yes No Have you ever been advised to have corrective surgery for a rupture? Yes No Allergies Do you have any known allergies? Yes No

If yes, what caused your allergy? ______________________________________________________________________ Are you currently taking medication(s) for your allergy? Yes No

How does this allergy affect you? _______________________________________________________________________

How does the medication(s) affect you? __________________________________________________________________

High Blood Pressure Have you ever been told that you have high blood pressure? Yes No Are you presently taking medication(s) to control your blood pressure? Yes No If you have high blood pressure, is your controlled blood pressure reading with in 139/89? Yes No Pain Do you suffer from back pain? Yes No If yes, is the pain severe enough to take medication? Yes No Have you ever pulled a muscle in your back? Yes No Are you currently under a doctor’s or chiropractor’s care for back pain? Yes No Do you suffer from arthritis? Yes No Does any type of physical activity cause pain or swelling in your muscles or joints? Yes No Are you currently being treated by a doctor for joint pain? Yes No Are you currently on medication(s) for pain or arthritis? Yes No

If yes, please list the medication(s)_____________________________________________________________________ General Have you ever been advised to avoid standing or sitting for long periods of time? Yes No Have you ever had to give up a job because of illness or injury? Yes No Are you currently taking medication(s) for nerves or depression? Yes No

If yes, please list the medication(s)_____________________________________________________________________ Have you ever been told to avoid certain types of work? Yes No Have you ever collected worker’s compensation? Yes No

If yes, for what? ___________________________________________________________________________________

If yes, for how long? ________________________________________________________________________________ Medications Please list any medication(s) taken regularly:

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________ I hereby certify that all statements and answers provided by me in this questionnaire are complete and true to the best of my knowledge. I hereby authorize any physician or any other person who has attended to me to make a disclosure to any member company of the TII family of companies, designated agents and subsidiaries of any information regarding my medical history. _____________________________________________ ______________________ Driver’s Signature Date _____________________________________________ _______________________ Reviewed by (Safety Associate Signature) Date

Random & Post Accident Drug & Alcohol Testing

Each unit leased to one of the TII family of companies will receive drug testing supplies. You will be responsible for having these drug testing supplies in your truck at all times. If the supplies are not in place when needed, any expense incurred in getting a replacement to the driver will be charged back to the owner of the truck. Random Drug Testing

Drivers selected for a random drug test will be notified verbally. You must proceed directly to an authorized collection site and submit to a urine collection. Note: All time spent submitting to the drug testing must be logged on line 4 (on duty, not driving) of your log book.

Random Alcohol Testing Drivers selected for a random alcohol test will be notified verbally while they are performing their “safety sensitive” function. You MUST be on duty immediately before and after testing. You must proceed directly to an authorized breath alcohol testing site and submit to a breath alcohol test. Note: All time spent submitting to the alcohol testing must be logged on line 4 (on duty, not driving) of your log book.

Post Accident Drug & Alcohol Testing Drivers involved in an accident resulting in a fatality or who are involved in a DOT accident, and are issued a citation for a moving violation as a result of the accident, are required to undergo post accident drug and alcohol testing. The breath alcohol test should be preformed within 2 hours of the accident, but no later than 8 hours after the accident. If the test is not done within 8 hours of the accident, all efforts to obtain the test must cease and documentation must be kept as to why the tests were not done. Post accident drug testing must be completed within 32 hours of the accident. Note: All time spent submitting to the drug and alcohol testing must be logged on line 4 (on duty, not driving) of your log book.

If you are required to have a post accident alcohol test outside of normal business hours, ask the investigation officer to perform the test. Per the regulation: Failure to report for testing as required will be treated as a refusal to test and the driver will be disqualified from driving and will be terminated. Please contact the safety department at (412) 490-6040 option 3 should you have any questions. ________________________________________ ______________________ Driver’s Signature Date

Hours of Service Certification

I, ______________________________________, an independent contractor or

driver for an independent contractor, have stated that I am familiar with all parts of the Federal Motor Carrier Safety Regulations, and in particular that I am fully conversant with the provisions of Part 395 - Hours of Service of Drivers. I specifically understand the importance of Part 395.3 (11 hour maximum driving time rule). I further understand that this rule must not be violated for any reason except as set forth in Part 395.10 and 395.11 of the Federal Motor Carrier Safety Regulations of the Department of Transportation.

This certification form is required by the ICC Lease & Interchange Vehicle Regulation (Part No. MC-43) and appendix B of the master contract.

The Driver must be familiar with the Hours of Service and Safety Regulations and must have been instructed not to violate such regulations. A copy of Drivers Hours of Service Certification from must be on file in the initial carrier’s office.

I hereby acknowledge receipt of a copy of the Federal Motor Carrier Safety

Regulations of the U.S. Department of Transportation (Part 390-397), I agree to familiarize myself with these regulations and to comply with the provisions at all times when on duty as a driver.

I further certify that I have been instructed pursuant to pre-trip inspection regulations of the Federal Motor Carrier Safety Regulations (Part 392.7) I understand that any fines assessed by me, due to noncompliance of section 395 of the Federal Motor Carrier Safety Regulations will be responsibility of the independent contractor. ____________________________________ _____________________ Driver’s Signature Date

INTRANSIT, LLC Alcohol and Controlled Substance Policy

Driver's Certified Receipt

Print Driver's Name This is to certify that I have been provided educational materials that explain the requirements of §382.601 and my carrier's policies and procedures with respect to meeting the requirements. The materials include detailed discussion of the following checked () items: 1. The designated person to answer questions about the materials. 2. The categories of drivers subject to Part 382. 3. Sufficient information about the safety-sensitive functions and periods of the workday that

compliance is required. 4. Specific information concerning prohibited driver conduct. 5. Circumstances under which a driver will be tested. 6. Test procedures, driver protection and integrity of the testing processes, and safeguarding the

validity of the test. 7. The requirement that tests are administered in accordance with Part 382. 8. An explanation of what will be considered a refusal to submit to a test and the consequences. 9. The consequences for Part 382 Subpart B violations including removal from safety-sensitive

functions and §382.605 procedures. 10. The consequences for drivers found to have an alcohol concentration of 0.02 or greater but

less than 0.04. 11. Information on the affects of alcohol and controlled substances use on:

an individual's health signs and symptoms of a problem work personal life available methods of intervening when a problem is suspected

12. Optional Information: AMERICAN FOR A DRUG FREE AMERICA

Driver's Signature Date

Authorized INTransit Representative Date

Retain a copy in Driver's Confidential File

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INTRANSIT, LLC DRIVER DECLARATION

Federal Motor Carrier Safety Regulations

Section 40.25(j)

Driver’s Name (Print) Social Security Number

Driver’s Signature Driver’s CDL Number Review the following statements carefully then check the one that applies:

I certify that I have not failed or refused a DOT Drug and/or Alcohol Pre-employment Test within the past three years from an employer who did not hire or use me.

I certify that I have failed or refused a DOT Drug and/or Alcohol Pre-employment Test within the past three years from an employer who did not hire or use me. The Drug and/or Alcohol Pre-employment that I failed or refused was for the following Motor Carrier:

Name of the Motor Carrier

Address of Motor Carrier

City, State, Zipcode

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This certifies that this application was completed by me, and that all entries on it and information in it are true and complete to the best of my knowledge. I understand that any misleading, incorrect or omitted statements may result in American Transport, American Wind Transport, Aetna Freight Lines, Greentree Transportation and/ or Marathon Transport denying my lease or, if I am leased on terminating my lease. I authorize American Transport, American Wind Transport, Aetna Freight Lines, Greentree Transportation and/ or Marathon Transport. or its agent, to contact any of my present or former employers or schools, and any law enforcement agencies, financial institutions or other persons having knowledge about me, my qualifications, motor vehicle record, motor vehicle license, Pre-Employment Screening Program (PSP Report) from the FMCSA, operating history, and criminal history from various private and public resources, along with other available public records, and/or my safety performance history. I further authorize each of the foregoing entities and/or persons to provide American Transport, American Wind Transport, Aetna Freight Lines, Greentree Transportation and/ or Marathon Transport with any and all information regarding me and/or my qualifications, and I release each of the foregoing entities, persons and American Transport, American Wind Transport, Aetna Freight Lines, Greentree Transportation and/ or Marathon Transport from any liability related to the providing and use of such information. I am willing that a photocopy of this authorization be accepted with the same authority as the original. I understand that my completion and/or submission of this application or related materials (such as my resume) does not create a contract or obligate American Transport, American Wind Transport, Aetna Freight Lines, Greentree Transportation and/ or Marathon Transport to consider me for lease. I further understand that if I am Leased by American Transport, American Wind Transport, Aetna Freight Lines, Greentree Transportation and/ or Marathon Transport, such Lease may be terminated at the will of either me or American Transport, American Wind Transport, Aetna Freight Lines, Greentree Transportation and/ or Marathon Transport, for any reason or no reason, with or without cause or notice. I authorize American Transport, American Wind Transport, Aetna Freight Lines, Greentree Transportation and/ or Marathon Transport to contact all employers listed on my application and any companies to whom I applied in the last three (3) years to verify the facts and information furnished in accordance with DOT regulations Parts 49 CFR 40 and 391. I further authorize each of the companies contacted by American Transport, American Wind Transport, Aetna Freight Lines, Greentree Transportation and/ or Marathon Transport to release to American Transport, American Wind Transport, Aetna Freight Lines, Greentree Transportation and/ or Marathon Transport all information concerning my safety performance history including, but not limited to alcohol tests with a concentration result of 0.04 or greater, verified positive drug tests, refusals to be tested (including verified adulterated or substituted drug test results), other violations of DOT agency drug and alcohol regulations, participation in rehabilitation, failures to complete rehabilitation, accidents history, and if I have violated a DOT drug and/or alcohol regulation and documentation of my successful completion of DOT return-to-duty requirements. I am willing that a photocopy of this authorization be accepted with the same authority as the original. I understand that the information I provide may be used, and my previous employers (including current employer) will be contacted, for the purpose of investigating my safety performance history. I understand that I have the right to review information provided by previous employers if I request such in writing no later than 30 days after being leased or denial to be leased. I further understand that I have the right to contact the previous employer providing such information to have errors in the information corrected by the previous employer and for that previous employer to resend the corrected information to American Transport, American Wind Transport, Aetna Freight Lines, Greentree Transportation and/ or Marathon Transport and the right to submit a rebuttal statement to the previous employer, to be attached to alleged erroneous information if I dispute the accuracy of such information. In connection with your application for lease with American Transport, American Wind Transport, Aetna Freight Lines, Greentree Transportation and/ or Marathon Transport (Motor Carrier) it may obtain one or more reports regarding your driving and safety inspection history from the Federal Motor Carrier Safety Administration (FMCSA). When the application for employment is submitted in person, if the motor carrier uses any information it obtains from FMCSA in a decision to not lease you or to make any other adverse lease decision regarding you, the motor carrier will provide you with a copy of the report upon which its decision was based and a written summary of your rights under the Fair Credit Reporting Act before taking any final adverse action. If any final adverse action is taken against you based upon your driving history or safety report, the motor carrier will notify you that the action has been taken and that the action was based in part or in whole on this report. When the application for lease is submitted by mail, telephone, computer or other similar means, if the motor carrier uses any information it obtains from FMCSA in a decision to not lease you or to make any other adverse lease decision regarding you, the motor carrier must provide you within three business days of taking adverse action oral, written, or electronic notification: this adverse action has been taken based in whole or in part on information obtained from FMCSA; the name, address and the toll free telephone number of FMCSA; that the FMCSA did not make the decision to take the adverse action and is unable to provide you the specific reasons why the adverse action was taken; and that you may, upon providing proper identification, request a free copy of the report and may dispute with the FMCSA the accuracy or completeness of any information or report. If you request a copy of a driver record from the motor carrier who procured the report, then, within 3 business days of receiving your request, together with proper identification, the motor carrier must send or provide to you a copy of your report and a summary of your rights under the Fair Credit Reporting Act. The motor carrier cannot obtain background reports from FMCSA unless you consent in writing. If you agree that the motor carrier may obtain such background reports, please read the following and sign below: I authorize American Transport, American Wind Transport, Aetna Freight Lines, Greentree Transportation and/ or Marathon Transport to access the FMCSA Pre-Employment Screening Program (PSP) system to seek information regarding my commercial driving safety record and information regarding my safety inspection history. I understand that I am consenting to the release of safety performance information including crash data from the previous five (5) years and inspection history from the previous three (3) years. I understand and acknowledge that this release of information may assist the motor carrier to make a determination regarding my suitability as a qualified leased independent contractor. I further understand that neither the motor carrier nor the FMCSA contractor supplying the crash and safety information has the capability to correct any safety data that appears to be incorrect. I understand I may challenge the accuracy of the data by submitting a request to https://dataqs.fmcsa.dot.gov. If I am challenging crash or inspection information reported by a State, FMCSA cannot change or correct this data. I understand my request will be forwarded by the DataQs systemto the appropriate state for adjudication. Please note: Any crash or inspection in which you were involved will display on your PSP report. Since the PSP report does not report, or assign, or imply fault, it will include all Commercial Motor Vehicle (CMV) crashes where you were a driver or co-driver and where those crashes were reported to FMCSA, regardless of fault. Similarly, all inspections, with or without violations, appear on the PSP report. State citations associated with FMCSR violations that have been adjudicated by a court of law will also appear, and remain, on a PSP report.

I have read, understand and by signing this release, consent to these statements.

Signed: _________________________________________________

Printed: _________________________________________________

Date: ________________

DRIVERS ONLY ►You are welcome to go for your drug screen at this time. Please take the Chain of Custody (carbon copy form) provided in the “For Your Records” envelope along with a copy of your CDL with you. ►Please return this Completed Driver Qualification booklet along with the following driver checklist items in the Pre-paid FedEx return envelope (you may drop this in any FedEx box or at any FedEx location). ►Upon receipt of all required items you will be contacted by Pittsburgh Corporate office to schedule your orientation. OWNER OPERATORS ►You are welcome to go for your drug screen at this time. Please take the Chain of Custody (carbon copy form) provided in the “For Your Records” envelope along with a copy of your CDL with you. ►Please utilize the following driver checklist and place all checklist items inside this packet for return. ►Please complete the “Owner & Equipment Packet” at this time. DRIVER CHECKLIST

□ Legible copy of current and valid Commercial Drivers License

□ Legible copy of your current and valid Medical Card

□ Legible & Complete copy of your current long form physical This long form physical must be the one that corresponds with your medical card provided.